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要旨 近年，進行精巣腫瘍の治療成績の向上は著しく，その大きな要因の1つはcisplatinの導入である。しかし化学療法単独では完全奏効は不可能であり，非セミノーマの残存腫瘍は外科的に切除する必要がある。残存腫瘍には線維化・壊死，成熟奇形腫，悪性腫瘍の組織がみられ，悪性腫瘍残存の予後は不良である。また奇形腫は徐々に増大したり，悪性化の危険性があり完全に切除することが重要である。残存腫瘍のサイズなどで術前に組織像を100％予測することはできないが，原発巣に奇形腫がなく，化学療法前のAFP，HCGが正常でLDHが高値，後腹膜腫瘍の縮小率が70％以上であれば線維化・壊死の可能性は90％以上である。このような症例で残存腫瘍が10mm未満のものは手術をせずに経過をみることも可能である。後腹膜以外の残存腫瘍と後腹膜腫瘍との組織像は半数近くで一致せず，残存腫瘍はすべて切除すべきである。また症例を選べば術前の腫瘍マーカーが陽性でも手術療法により比較的良好な成績が得られるので，安易に化学療法を繰り返さず患者のQOLを考慮した治療戦略を立てることが重要である。セミノーマの残存腫瘍はしばらく縮小の程度を観察したのち30mm以上であれば切除術を行うが，線維化が強く手術に難渋することが多い。
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